Pronatus syndromes of the hindfoot often represent a deformity in patients of developing age. They are characterised by internal valgus rotation and adduction of astragalus, calcaneous pronation and valgus tibial-calcaneous axis. During the walking phase, the astragalic leaning phase is increased with a consequence of wider pronation of the forefoot. This often creates a functional compensation of the joint and of the myotendinous structures of IMF and progressive valgus deviation of the hallux. In the last few years, many different techniques to correct and to stabilise the altered alstagalus-calcaneous relation have been introduced. This altered relation represents the ‘primum movens’ of this deformity through the stimulation of the endotarsal proprioreceptors; this evokes some inputs that allows the capsular ligaments a retraction structure during the development. In the period between April 2001 and December 2003, in the 1st Clinica Ortopedica of the Bari University, 30 patients (16 males and 14 females; age range between 7–12 years, median age 9.6 years) with pronatus syndrome were treated with surgical astragalus-calcaneous arthrorisis according to Pisani; 27 patients were operated bilaterally. All patients (57 feet) were evaluated at a median follow-up of 15.3 months (range 2–32 months). Clinical and radiological results have shown alignment of the hind-foot and normal plantar part of the foot. These data confirms that the astragalus-calcaneous arthrorisis represents a valid technique in the pronatus syndrome.
In the correction of hallux valgus, there are many different treatments with the aim to resume angular values I MF (metatarsal-phalangeal), I IM (intermetatarsal), PASA (proximal articular set angle), sesamoid position, to improve transferring metatarsal pain and the aesthetics of the forefoot. From November 2001 to November 2003, in the 1st Clinica Ortopedica at Bari University, 40 patients were treated for hallux valgus (nine males and 31 females). The age ranges from 17 to 82 years of age (median age: 50 years). The correction technique is based on a distal metatarsal osteotomy (modified Chevron techniques) and fixation with ‘hallux splint’ interfragmentation dynamic and compression device (Waldemar Link GmbH &
Co Hamburg, Germany). This technique give intra-operative stability of the osteotomy, giving free weight-bearing from the beginning in the post-operative phase and the complete resumption of daily activities in a short period of time. At a median follow-up of 2 months, a significant improvement in the angular values is shown by radiological evaluation. Therefore, the result shows that this surgical technique is valid in the correcting hallux valgus.
